Provider Demographics
NPI:1578812962
Name:SWAIN, JARED WILLIAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:WILLIAM
Last Name:SWAIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MADISON AVE S
Mailing Address - Street 2:KMART PHARMACY
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-4404
Mailing Address - Country:US
Mailing Address - Phone:912-384-0144
Mailing Address - Fax:912-384-0252
Practice Address - Street 1:1300 MADISON AVE S
Practice Address - Street 2:KMART PHARMACY
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-4404
Practice Address - Country:US
Practice Address - Phone:912-384-0144
Practice Address - Fax:912-384-0252
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist